Suffolk Local History Council - Printable Application Form for Membership

PLEASE PRINT & COMPLETE THIS FORM AND SEND IT TO:-
The Hon. Membership Secretary, Suffolk Local History Council,
Suffolk Community Resource Centre, 2 Wharfedale Road, IPSWICH IP1 4JP

Name _________________________________________________________________________

Address _______________________________________________________________________

_________________________________________________ POST CODE _________________

I enclose a cheque for £ ______ for a single (£7.50) joint, society, overseas (£10) for the first year's subscription

STANDING ORDER

To: (name of your bank) _________________________________________________________

Address: _____________________________________________________________________

My account no. ____________________________________ My sort code _____/_____/_____

Please pay Suffolk Local History Council, Account no. 70867942 at Barclays Bank plc, 1 Princes Street, Ipswich, code 20-44-51, the sum of £______________ on 1 October 20____ and on 1 October each year until further notice from me.

Name ________________________________________________________________________

Address ______________________________________________________________________

________________________________________________ POST CODE__________________

Signed ___________________________________________ Date: ______________________

GIFT AID

Suffolk Local History Council benefits to the extent of just over 20 pence in every £1 if you pay income tax and sign this form.

FULL NAME (block capitals) ______________________________________________________

ADDRESS ____________________________________________________________________

__________________________________________________ POST CODE ________________

I confirm that I am a United Kingdom Taxpayer YES / NO

Signed ____________________________________________ Date: _______________________

I will inform you if I cease to be a U.K. tax payer or resident in the U.K. for tax purposes.
Registered Charity no. 294270

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